audit on hypertension in northwest russia Архангельск ingvar ovhed, md, phd, family...
TRANSCRIPT
Audit on Hypertension in Northwest Russia
Архангельск
Ingvar Ovhed, MD, PhD, family physician, Competence Center, Blekinge County Council 2008
Archangelsk region
The structure of this regional report is built up from
a Powerpoint presentation with comparative graphs.
You will find blue graphs showing the results from the whole of
NWR and green graphs from the regional registration.
Notice! – The comments below the pictures are made according to
the results of the whole audit group of 146 family doctors in
Northwest Russia. The results from the regional (green) audit may
differ. Make that an reason for discussing interesting regional
specific clinical policies.
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Audit on Hypertension in Northwest Russia
Distribution of age groups
Archangelsk
Age: mean values for men: 54,4 years and for women 58,6 yearsComments: When looking on the distribution of the age groups it’s obvious that the family doctors control and treat men at a younger ages than for women.
Распределение по возрастным группам и в зависимости от пола
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Пр
оц
енты
Мужчины 10,8 18,2 29,5 24,0 17,5
Женщины 5,7 16,4 30,6 22,3 25,0
<40 40-49 50-59 60-69 ≥70
Distribution of age groups by gender
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
Per c
ent
Men 8,3 13,0 29,1 25,3 24,3
Women 3,6 10,3 27,0 26,4 32,7
<40 40-49 50-59 60-69 ≥70
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Audit on Hypertension in Northwest Russia
Number of patients in each age group
Archangelsk
However, the distribution up to absolute numbers (figure 2) tells us that in spite of this the female patients are more numerous in each age group. Question: Where are the men checked up? Nowhere or by cardiologists?
Количество пациентов в каждой возрастной группе
0
500
1000
1500
2000
Чис
ла
Мужчины 246 416 674 548 400
Женщины 290 835 1559 1136 1274
<40 40-49 50-59 60-69 ≥70
Number of patients in each agegroups
0
100
200
300
400
500
nu
mb
ers
Men 49 77 172 150 144
Women 46 130 341 334 413
<40 40-49 50-59 60-69 ≥70
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Audit on Hypertension in Northwest Russia
Systolic blood pressure
ArchangelskСистолическое кровяное давление в зависимости от пола
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Про
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ы
мужчины 9,6 13,5 19,8 19,4 25,7 10,6
женщины 8,5 12,9 19,9 16,9 28,1 11,9
<130 130-139 140-149 150-159 160-175 >175
Systolic blood pressure by gender
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5,0
10,0
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25,0
30,0
35,0
Per c
ent
men 15,7 19,4 24,8 15,2 17,2 7,4
w omen 12,9 15,5 23,7 13,1 22,4 12,4
<130 130-139 140-149 150-159 160-175 >175
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Audit on Hypertension in Northwest Russia
Diastolic blood pressure
Archangelsk
Comments: For both systolic and diastolic blood pressure women have a somewhat bigger proportion of high values. This may be due to that women are older, but among those with very high blood pressure (>200/110) there are more men.Question: Discuss your techniques for measuring blood pressure.
Диастолическое кровяное давление в зависимости от пола
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45,0
Про
цент
ы
мужчины 5,7 29,7 36,9 21,4 4,9
женщины 6,0 29,9 35,9 22,1 4,4
<80 80-89 90-99 100-109 ≥110
Diastolic blood pressure, by gender
0,0
5,0
10,0
15,0
20,0
25,0
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35,0
40,0
45,0
Per c
ent
men 9,5 41,4 29,2 16,9 2,9
w omen 8,3 40,4 30,9 17,5 2,8
<80 80-89 90-99 100-109 ≥110
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Audit on Hypertension in Northwest RussiaMean blood pressure by gender
Archangelsk
Comments: Most obvious are the similarities, but it is important to notice that women as a group is older and when you get old your blood pressure will raise. Goal BP for all: For those <60 years old 37,3% men and 38,8% women have reached the goal; ≤140/90. For those ≥60 years old 59,6% men and 56,3% women have reached the goal; ≤160/90. In Vologda the figures for those <60 years were 127/249 (51%) for men and 259/485 (53%) women and still higher for those ≥60 years or 81/123 (66%) for men and 232/310 (75%) for women Question Is it even in Vologda possible /desirable to increase the proportion who reach their goal BP?
Среднее кровяное давление в зависимости от пола
0
50
100
150
200
Мужчины 150,5 89,9
Женщины 151,6 89,6
Систолическое КД Диастолическое КД
Mean blood pressure by gender
0
50
100
150
200
Men 144,4 86,7
Women 148,7 87,1
Systol BP Diastol BP
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Audit on Hypertension in Northwest Russia
Who measures the blood pressure BP?
Archangelsk
Comments: Obviously the doctor measure the patients BP almost every time. Would it be possible to change such routines?Question: Advantages or disadvantages with a doctor who trusts the BP measured by the nurse?
Кровяное давление измерялось доктором или медсестрой
92,5
10,0
0,0
20,0
40,0
60,0
80,0
100,0
Доктор Медсестра
Про
цент
ы
Blood pressure measured by doctor or nurse
95,1
5,5
0,0
20,0
40,0
60,0
80,0
100,0
Doctor Nurse
Per
cen
t
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Audit on Hypertension in Northwest RussiaRiskfactors by gender
Murmansk
Comments: There is no differences between men and women up to heredity – and heredity for CVD is common - 60%. Smoking women are less than 20%, but they have more over weight and more diabetes, while men have more of cardiovascular disease other than diabetes. Question: Why these differences between men and women? Do you meet men before or after their first acute heart attack?
Факторы риска в зависимости от пола
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Про
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ы
Мужчины 63,6 77,3 40,0 45,3 49,7 45,5 10,6 43,1
Женщины 63,4 15,1 41,5 61,6 56,2 50,1 16,2 32,5
Наследственность
ССЗ
Курильщики, Х-
Курильщ
Гиперхолест.
Избыточный вес
Низкий ур. физ.
активност
Только гипертони
я
Гипертония +
диабет
Гипертония + ССЗ
Riskfactors by gender
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
Per
cen
tMen 61,1 76,8 39,2 44,3 51,0 41,9 9,3 45,8
Women 63,8 11,1 46,0 58,3 59,3 44,8 18,9 32,0
Heredity for CVD
Smokers, X-
smokers
Hyperchol.
Overw eigth
Low physical activity
HT onlyHT +
diabetesHT + CVD
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Audit on Hypertension in Northwest RussiaSmoking and x-smoking by age and gender
Archangelsk
Comments: Smoking is a world-wide epidemic now increasing especially among young women. Figure 8 shows that the young women now increase smoking. Noteworth is that there are 25% (61/244)X-smokers among men below 50 years of age but only 14% (49/358) among women. It is a well known fact that women seem to have more difficulties to stop smoking. Question: The youngest men smoke a little less than those between 40 and 60 years. Is there a tendency towards more healthy lifestyle among young Russian men
Курильщики и Х – курильщики среди мужчин и женщин
0,0
20,0
40,0
60,0
80,0
100,0
Пр
оц
енты
Мужчины 74,8 82,0 79,1 76,5 72,5
Женщины 37,2 26,6 16,4 9,9 5,8
<40 40-49 50-59 60-69 ≥70
Smoking and x-smoking by gender
0,0
20,0
40,0
60,0
80,0
100,0
Per
cen
t
Men 67,3 79,2 81,4 77,3 72,9
Women 30,4 31,5 13,2 8,1 3,1
<40 40-49 50-59 60-69 ≥70
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Audit on Hypertension in Northwest Russia
Medication by gender
Archangelsk
Comments: Females patients have more of diuretics and less of betablockers, while men have more of ASA and statins. This could perhaps be rational up to that women as a group are older and men have more of CVD
Медикаменты в зависимости от пола
0,0
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Проц
енты
Мужчины 48,9 73,7 46,6 21,7 9,5 46,5 23,6
Женщины 54,5 73,9 41,9 25,4 10,8 37,6 19,9
ДюретикиACE-
инхибиторыБетта-
блокаторыАнтогонист
кальцияДругие
Ацетил Салицилова
Статин
Medication by gender
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70,0
80,0
Per c
ent
Males 42,6 76,9 46,6 24,7 5,6 45,3 22,6
Females 50,3 74,4 37,3 28,4 7,4 38,1 22,6
Diuretic ACE-inh Betabl Ca-ant Other ASA Statin
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Audit on Hypertension in Northwest RussiaChoice of drugs due to risk factors
Archangelsk
Comments: Patients with CVD or Diabetes have got a more intense medication and all different drugs are used for this. This result indicate that the family doctors really try to give these patients as efficient therapy as possible.Question: Discuss the different medication to men and women as well as the differences up to those with complicating disease. Could it be better?
Медикаменты в зависимости от риска
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
Проц
енты
Только гипертония 45,2 66,7 37,2 18,0 8,2 20,6 11,4
ССЗ + Диабет 60,5 81,2 49,6 30,5 12,6 60,4 30,7
ДюретикиACE-
инхибиторБетта-
блокаторыАнтогонист кальция
ДругиеАцетил
СалициловСтатин
Medication by risk
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
Per c
ent
HT only 41,5 63,8 33,7 17,6 5,0 17,6 13,0
CVD + Diabetes 52,9 85,9 46,1 34,2 8,2 59,9 29,6
Diuretic ACE-inh Betabl Ca-ant Other ASA Statin
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Audit on Hypertension in Northwest Russia
Medication due to dr’s satisfaction
Archangelsk
Comments: It is obvious that if the family doctors are not satisfied with the therapy they will increase medication.
Медикаменты в зависимости с удовлетворением врача
0,0
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70,0
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Про
цент
ы
Врач удовлетворен 51,0 74,0 42,5 20,2 8,9 40,0 19,3
Врач НЕ удовлетворен 58,0 72,9 45,8 34,8 13,1 39,7 21,0
Дюретики
ACE-инхибит
Бетта-блокато
Антогонист
ДругиеАцетил
СалицилСтатин
Medication in relation to doctors satisfaction
0,0
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Per c
ent
Dr satisfied 42,9 76,0 41,6 21,0 5,9 44,0 21,4
Dr NOT satisfied 58,0 76,6 42,8 39,1 9,2 40,8 24,2
Diuretic ACE-inh Betabl Ca-ant Other ASA Statin
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Audit on Hypertension in Northwest RussiaDr’s evaluation of therapy and check up
Archangelsk
Comments: Change of therapy is carried out as often for men as for women.Question: Discuss the problematic patients – what different problems do you meet when deciding about medication?
Оценка лечения доктором и обследования
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70,0
Пр
оце
нты
Мужчины 20,9 62,0 50,8
Женщины 20,3 63,8 49,9
Изменение лечения
Доволен лечениемНовое
обследование
Doctors evaluation of therapy and check up
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
Per
cen
t
Males 28,5 60,6 47,3
Females 27,4 60,4 47,8
Change of therapy Satisfied w ith therapy New check up
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Audit on Hypertension in Northwest RussiaDr’s satisfaction and change of therapy
Archangelsk
Comments: Doctors are satisfied to the same extent up to men and women, but less often for those patients with complicating diabetes and/or CVD. For these patients the family doctors take an active role and more often change medication. This is of great importance out of a public health and preventive care perspective.Question: Discuss what priority you have personally, up to what drugs you choose and in what order you use them.What different drugs do you give priority for men or for women, for old people or for young ones, for uncomplicated and for complicated diseases?
Удовлетворение лечением или изменение лечения доктором у пациентов только с гипертонией или с диабетом или ССЗ
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Про
цент
ы
Мужчины: толькоГипертония
64,9 20,2
Мужчины: Диаб. Или ССЗ 59,7 21,9
Женщины: толькогипертония
65,9 19,8
Женщины: Диаб. Или ССЗ 61,7 20,9
Доволен лечением Изменил лечение
Doctor's satisfaction and change of therapy for patients with HT only or CVD or diabetes
0,0
10,0
20,0
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40,0
50,0
60,0
70,0
80,0
Per c
ent
Male: HT only 55,2 30,6
Male: Diab or CVD 65,4 27,5
Female: HT only 60,6 24,9
Female: Diab or CVD 60,4 29,4
Satisfied with therapy Change of therapy
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Audit on Hypertension in Northwest RussiaComparison of risk factors - men
Archangelsk
Сравнение по факторам риска для мужчин только с гипертонией, диабетом или ССЗ
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50,0
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Проц
енты
Только гипертония 50,7 64,7 76,8 30,9 42,3 41,3
ССЗ или диабет 61,4 62,8 78,2 49,0 48,4 57,4
Средний возраст
Наследственность ССЗ
Курильщики, Х-
Курильщики
Гиперхолест.
Избыточный вес
Низкий ур. физ.
активности
Comparison or riskfactors for men with hypertension only respectively diabetes or CVD
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
Per c
ent
HT only 53,0 61,7 73,7 34,3 39,1 41,5
CVD or Diab 63,3 61,4 79,9 44,8 49,1 59,6
Age meanHeredity for
CVDSmokers, X-
smokersHyperchol. Overweigth
Low physical
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Audit on Hypertension in Northwest RussiaComparison of risk factors - women
Archangelsk
Comments: There is a lower proportion of smokers among those with CVD and diabetes. Especially among women this might be explained by the age factor. There is no obvious difference up to hypercholesterolemia but to over weight and low physical activity. Both men and women of those with complicated diseases have a higher proportion of negative lifestyle risk factors. However even here the higher age among those with complications will be important, but it makes it reasonable to invest resources on preventive care also for these very sick people. Question: In what way and for what groups could preventive care be most effective do you think?
Сравнение по факторам риска для женщин только с гипертонией, диабетом или ССЗ
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
Только гипертония 54,2 61,9 19,5 31,5 58,2 49,3
ССЗ или диабет 64,8 65,2 10,5 52,4 66,1 64,0
Средний возраст
Наследственность ССЗ
Курильщики, Х-Курильщики
Гиперхолест.Избыточный
весНизкий ур. физ.
активности
Comparison or riskfactors for women with hypertension only respectively diabetes or CVD
0,010,020,030,040,050,060,070,080,0
HT only 57,1 65,4 15,7 35,2 56,4 54,6
CVD or Diab 67,4 64,0 6,7 56,5 62,3 65,1
Age meanHeredity for
CVDSmokers, X-
smokersHyperchol. Overweigth
Low physical
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Audit on Hypertension in Northwest Russia
One or multiple drug therapy by gender
ArchangelskМедикаменты в зависимости от пола
0,0
20,0
40,0
60,0
80,0
100,0
Про
цент
ы
Мужчины 0,7 18,5 80,8
Женщины 1,0 19,9 79,1
Лекарства от гиперт. не назначены
Одно лекарство от гиперт.
2 и более лекарств от гиперт.
Medication by gender
0,0
20,0
40,0
60,0
80,0
100,0
Per
cen
t
Men 1,0 22,8 76,2
Women 0,6 23,1 76,3
No hypertensive drug One hypertensive drugsTw o or more hypertensive
drugs
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Audit on Hypertension in Northwest Russia
ArchangelskOne or multiple drug therapy by risk
Comments: When we look at high risk patients we can see that only a few of those patients with Diabetes or CVD have just one antihypertensive drug.Question: What is your own additional drugs to prescribe when you meet a patient with diabetes or CVD? What is your own opinion – low doses of two or three drugs or higher doses of one or two?
Медикаменты в зависимости от факторов риска
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
Про
цент
ы
Только гиперт. 1,1 31,4 67,5
ССЗ или диабет 0,5 7,2 92,3
Лекарства от гиперт. не назначены
Одно лекарство от гиперт.
2 и более лекарств от гиперт.
Medication by risk
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
Per c
ent
HT only 0,6 39,7 59,7
CVD or Diab 0,4 9,6 90,0
No hypertensive drug One hypertensive drugsTw o or more hypertensive
drugs
Audit on Hypertension in Northwest Russia
Mean values
With St; M: 6,76 W: 6,58
Without St: M: 6,24, W: 6,43
Гиперхолестеринемия с или без Статина, мужчины n: 327 и 345 респондента
0,0
5,0
10,0
15,0
20,0
25,0
30,0
Пр
оц
енты
Со Статином 1,5 1,8 3,4 3,1 10,7 23,5 19,6 19,9 8,3 7,6 0,6
Без Статина 2,3 4,3 2,9 10,4 15,4 25,5 15,7 14,2 4,1 4,1 1,2
<4 4-4,44,5-
4,95-5,4
5,5-
5,9
6,0-
6,4
6,5-
6,97-7,4
7,5-
7,98-8,9 >=9,0
Гиперхолестеринемия с или без Статина, женщины n: 673 и 933 респондента
0,0
5,0
10,0
15,0
20,0
25,0
30,0
Пр
оц
енты
Со Статином 1,0 1,2 2,7 6,8 12,6 17,8 19,5 17,7 9,5 8,9 2,2
Без Статина 1,3 1,5 3,9 9,4 16,5 23,9 19,2 14,4 4,0 4,8 1,2
<4 4-4,44,5-
4,95-5,4
5,5-
5,9
6,0-
6,4
6,5-
6,97-7,4
7,5-
7,98-8,9 >=9,0
Комментарии: как у мужчин, так и женщин, употребляющих лекарства Статин более высокие показатели, чем у тех, которые Статин не употребляют.
Вопрос: Какие выводы из этого Вы можете сделать?
Гиперхолестеринемия С или Без Статина
Comments: For both men and women those with Statin medication have higher values than those without Statin. Question: What is your conclusion of this fact?
All men All women